CMS Price Transparency Data

Physical therapy (manual therapy)

Facility: Essentia Health Sandstone

Billing Code: 97140 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97140
Insurance Median: $86
Cash Discount Price: $92
vs. Medicare Baseline: 3.10x Medicare

The contracted insurance negotiated median rate for a Physical therapy (manual therapy) at Essentia Health Sandstone is $86. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $92. Compared to the federal Medicare reimbursement reference rate of $27.72, this hospital’s rate is 3.10x the Medicare baseline. Located in 705 Lundorff Drive South, Sandstone, MN.

Cash / Self-Pay

$92

Average discount available for prompt cash payment at this facility.

Insurance Median

$86

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$27.72

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $27.72 (100%)

Cash / Self-Pay: $92 (332%)

Insurance Median: $86 (310%)

Cash: $92 (332% of Medicare)

Ins. Median: $86 (310% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $27.72 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 310% of the Medicare baseline (a markup of 210%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Itasca Med Care	$27	97%
Primewest	$27	97%
Blue Cross Blue Shield	$48 - $100	173%
Blue Plus Pmap Pcc Prime	$48 - $69	173%
Healthpartners Care Pmap	$50	180%
Medica Access	$50 - $78	180%
Sanford Healthplan	$54 - $56	195%
Advocare/Security Health	$59	213%
Freedom Blue Ppo	$59	213%
Healthpartners Care Msho / Mcr Adv	$59	213%
Imcare Msho Pcc Prime	$59	213%
Imcare Msho Ref Req	$59	213%
Medica Advantage Solutions	$59	213%
Medica Msho/Dual Solutions	$59	213%
Medica Prime Solution Group	$59	213%
Medicare (plans)	$59	213%
Nd Va Administration	$59	213%
Platinum Blue/Vantage Blue	$59	213%
Primewest Msho	$59	213%
Secure Blue Msho	$59	213%
Ubh Cost Plan	$59	213%
Ubh Msho	$59	213%
Ucare Msho	$59	213%
UnitedHealthcare	$59 - $114	213%
Ucare	$82	296%
Healthpartners	$84 - $100	303%
Medica	$89 - $99	321%
Medica Uplan	$89	321%
Wea	$90 - $96	325%
America'S Ppo	$97	350%
Cigna	$98 - $100	354%
Healthpartners Pcc Prime	$98 - $100	354%
Medica Choice	$102	368%
Wps	$104 - $105	375%
Aetna	$106	382%
Security Health	$125	451%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $92.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97140.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Essentia Health Sandstone is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 97140.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.